On the picket line with the Tufts nurses

AFTER MONTHS of stonewalled negotiations and an overwhelming 95 percent strike vote, 1,200 registered nurses at Tufts Medical Center drew a line in the sand and went on a one-day strike on Wednesday--with management threatening to lock out union nurses for an additional four days.

The nurses, members of the Massachusetts Nurses Association (MNA), launched the first Boston hospital strike in 30 years. They're up against not only an anti-union hospital management, but also the larger profit-squeezing health care system that's been embraced by Democrats and Republicans alike.

Tufts nurses have been working without a new contract since July 30, 2016. Tufts has the lowest nurses' wages in all of Boston's many hospitals, but the hospital demanded cutbacks on pensions and vacation time anyway.

During the contract fight, management has attempted to intimidate workers in captive-audience meetings to make their anti-union case. It vows to cut the reduction-in-force layoff pay as of the first day of the strike and is threatening to lock out nurses for an additional four days.

Still, the nurses remain unbowed. As Rosemary, an ambulatory department nurse, put it to SocialistWorker.org back in April, "I've been working here 30 years. I've never seen solidarity like this."

WITH THAT solidarity, these nurses aren't just fighting for wages and benefits--they are mainly fighting for better working and caring conditions. Tufts has understaffed their units for years, the patients have suffered, and the nurses have had it. Eileen, a case manager who braved two fresh knee surgeries to picket in April, told SocialistWorker.org, "We're constantly being asked to discharge, discharge, discharge."

The union has hundreds of unsafe staffing forms written by nurses on the job. Management's solution has been last-minute text message blasts to cover shifts.

At this point, Tufts management isn't budging. The hospital claims not to have the money for better staffing, better pay and a robust retirement plan that covers all nurses. But the truth is that paying nurses is simply not a priority.

Nurses have seen former CEO Eric Beyer receive 18 percent and 45 percent pay boosts from 2012 to 2014--right before he left Tufts--and current CEO Michael Wagner get a 70 percent boost between 2013 and 2014.

Tufts also dropped a pretty penny to hire one of the top anti-union law firms in the country, Littler Mendelson, and it is planning to spend some $6 million to pay and train 320 scab nurses--not only to use for the one-day strike, but to lock out union nurses for four days afterward.

It's true that Tufts Medical Center has faced operating losses in recent years: It suffered a net loss of $16.8 million in 2015 and, in 2016, it had an operating loss of $2.6 million--although it gained $14.9 million in net income when including its Wall Street investments.

By Tufts CEO Wagner's own admission, however, 2015's temporary losses resulted from one-time expenses and a failed merger with Boston Medical Center (BMC). So the attempts to plead poverty in the media shouldn't be taken seriously.

THE VILLAINS in this tale go beyond a single greedy hospital corporation. They include the larger system of health care in the U.S., which is organized not to meet the medical needs of patients and communities, but according to the capitalist rules of profit and competition.

Tufts is in the business of selling health care, and it lacks the resources of Boston competitors like Massachusetts General Hospital and the Harvard-connected Brigham & Women's Hospital.

So Tufts needs to "grow in patient volume" (add more customers) and "stay current with health care trends" (keep up with competitors). In recent years, it has merged and formed a network with Lowell General Hospital and Hallmark Health to funnel customers to Tufts.

Tufts also has long-term construction plans in mind--demolishing five or six old buildings and reorganizing and expanding its facilities--and it wants to add more patient beds and expand its research facilities, which generated $49.6 million in revenue in 2016. All of this, of course, requires ever more money.

So Tufts squeezes nurses. Nurses deliver 90 percent of the clinical care patients receive. By making one nurse cover the work of two or three, the hospital squeezes more money from each nurse with every patient they bill.

Despite whatever it may say about patient care, management's willingness to leave patients without enough nurses, even well before the strike, tells us that its top priorities are its own profits and expansion.

IN RECENT years, this relentless competition among hospitals has gotten fiercer, thanks to devastating budget cuts pushed by both Republicans and Democrats.

American health care is a private system funded by public programs. Medicaid and Medicare alone accounted for about $1 trillion of the total $2.8 trillion spent on health care in 2012.

Many hospitals like Tufts rely on reimbursements from public health care programs. In 2015, 62 percent of Tufts's patients used a public health care program to pay. In 2016, more than half of Tufts's $787.4 million net patient service revenue came from Medicare and Medicaid.

That revenue has been under severe threat, first from Barack Obama's Affordable Care Act (ACA) and now the Republicans' proposed American Health Care Act (AHCA).

The ACA cut over $700 billion from Medicare over 10 years through reducing step payment increases that would keep up with inflation. The Republicans' current health care proposals would cut Medicaid by $772 billion (in the Senate version) or $834 billion (in the House version) over 10 years.

Massachusetts has suffered its own version of these cuts. Last year, the Democratic-dominated state legislature approved Republican Gov. Charlie Baker's budget that cut MassHealth by $142 million. The cuts were approved by votes of 150-to-3 in the state House and 38-to-1 in the state Senate.

What is the result of all these cuts? Some hospitals can fill in the lost revenue by overcharging private insurance companies, which then pass those costs along to their consumers. But as the Massachusetts Hospital Association states:

Hospitals with relatively few patients covered by private insurance cannot shift a significant portion of the costs tied to government underpayment. The result: negative operating margins, reduced services, reduced staff, and an inability to access capital markets to acquire funds to adequately maintain their facilities.

The same Massachusetts Democratic Party politicians who walk the nurses' picket line, give rousing speeches and declare their support for the fight are some of the very culprits responsible for the conditions that drove nurses to fight in the first place.

TUFTS HAS a record of going after workers. In 2015, during that same failed BMC merger, the 1199SEIU health care union tried to organize service, clerical and technical jobs at Tufts. These workers faced the kind of vicious response that nurses are facing now: anti-union propaganda meetings and threats to replace workers who showed interest in SEIU.

Now, the hospital wants to make nurses bear the costs of both government budget cuts and its own plans for expansion. Tufts is likely seeking to impose a contract if negotiations reach an impasse or if they can scare nurses into submission through scabs.

But nurses and their co-workers and supporters have the power to resist these plans. A successful strike will require solidarity, which starts most importantly with the strong bonds that nurses have built across their units and teams.

Though RNs have a special strength from the direct care they give, certified nursing assistants and service, clerical and technical workers also make the hospital run. They have grievances of their own, but also ones that should be familiar to nurses. As one 18-year veteran float nursing assistant told SocialistWorker.org: "Over the years, I've been paid the same, but I'm doing more and more and more work."

Solidarity can also be built within the city, among patients who rely on Tufts Medical Center and with members of other labor unions. Everyone who supports workers' rights and a better health care system should all come out and support the nurses on the picket line.

We can't trust the same politicians whose cuts are driving these cutbacks when they claim to stand with the nurses. Instead we have to build solidarity among students and working people to support the strike, and connect it with the need for a single-payer, Medicare-for-all program.